Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 00204734 | CO |
NPI | 1124694898 |
---|---|
Provider Name | Mr. Vincent D Markovitz |
First Address | Columbia, MO 65203-2821 |
Second Address | Colorado Springs, CO 80916-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |